Published online May 27, 2022. doi: 10.4254/wjh.v14.i5.1038
Peer-review started: December 22, 2021
First decision: February 15, 2022
Revised: April 24, 2022
Accepted: April 24, 2022
Article in press: April 24, 2022
Published online: May 27, 2022
Transjugular intrahepatic portosystemic shunt (TIPS) is a method used to decrease portal hypertension. Biliary stricture is the rarest of the complications associated with this procedure with only 12 cases previously reported in the literature. None of these cases have documented the resolution of biliary stenosis induced by a stent graft. The only curative solutions reported are liver trans
This is the first reported case of biliary obstruction secondary to TIPS placement in a transplanted liver. In our patient, a portosystemic shunt was created to treat severe veno-occlusive liver graft disease manifesting itself primarily by fluid retention. A cholestatic liver lesion and cholangitis with abscesses developed due to a stent graft-induced stricture in the dorsal segment of the right hepatic duct and the stricture diminished following percutaneous drainage. Endoscopic drainage was performed after unsuccessful removal of the percutaneous catheter resulting in a bilio-cutaneous fistula. Although the liver graft now functions well, the stricture remains refractory even after 44 mo of treatment.
Biliary strictures caused by TIPS in both transplanted and native livers seem refractory to endoscopic treatment.
Core Tip: Biliary stricture is the most unusual complication of transjugular intrahepatic portosystemic shunt (TIPS) implantation yet to be reported in liver transplant recipients. In our patient, TIPS was successfully used to treat the rare liver graft disease, sinusoidal obstruction syndrome. Cholangitis with abscess formation caused by a TIPS-induced stricture of the right hepatic duct was successfully treated by percutaneous and subsequent endoscopic drainage and resulted in preserved liver graft function. However, the stenosis persisted even after long-term endoscopic treatment. The outcome of our case is comparable to those reported in a native liver where no case was resolved using only biliary drainage.